Expansion of Medicaid Related to Improved Quality of Care at Health Centers

Medicaid expansion under the Affordable Care Act (ACA) is correlated with improved quality of care at federally funded community health centers. These centers serve more than 20 million people each year, most of whom are poor.1

Many states (n=31) and the District of Columbia extended Medicaid to nonelderly residents with incomes at or below 138% of poverty. Many poor people use federally funded community health centers for care, so researchers assessed what difference expansion of Medicaid made for the quality of care at these health centers.

This study followed changes in insurance coverage, the number of patients receiving care at these centers, and 8 measures of quality of care among approximately 20 million people per year at 1057 community health centers between 2011 and 2014.

This study also compared similar centers in states that expanded Medicaid and states that did not. In 2014, states in which Medicaid expanded experienced an 11.1% decrease in uninsured rates vs. nonexpansion states compared to 2011-2013.

Over the same time, the relative increase in Medicaid coverage was 11.8% higher for centers in expansion states. Approximately 23% of health center patients in expansion states and 39% in nonexpansion states remained uninsured in 2014.

Therefore, many more patients went to health centers for care in 2014 and were more likely to have health insurance in the expansion states. As a result, patients in expansion states were more likely to contribute to revenue for their health center. These patients were also more likely to be able to purchase prescriptions and to access specialty care.

Quality of care in the expansion states also improved slightly from 2011-2013 to 2014 on 7 of 8 tracked measures. In the nonexpansion states, however, the quality of care improved in 5 of 8 tracked measures and worsened in 2 of 8 measures.

"We do see relative improvements in some of these measures," said first author Megan Cole, a graduate student in the Department of Health Services, Policy, and Practice at the Brown University School of Public Health, in Providence, Rhode Island.

"Prior to expansion we see similar trends in both expansion and nonexpansion states but then we see a deviation in 2014. Some of it is due to slight declines in quality in the nonexpansion states, and some of it is due to greater improvements in quality in the expansion states."